Abstract

Background

Symptomatic aseptic necrosis (SAN) followed by nodule rupture is a kind of severe complications after thermal ablation for benign thyroid nodules (BTN). No studies are available to evaluate its pathologic process, clinical manifestations, risk factors and effectiveness of therapies after microwave ablation (MWA).

Methods

From 2012 to 2019, 398 patients who received MWA for BTN were retrospectively reviewed. Clinical data included baseline patient characteristics, imaging features (internal vascularity and the proportion of the solid component), ablation power and time, complications and prognosis were collected and documented.

Results

Ten patients (2.51%) experienced post-MWA SAN, eight patients with nodule rupture and the other two without. The mean time from MWA to SAN symptom was 8.6 days and to rupture was 16.3 days. The initial symptoms of SAN patients were neck bulging, swelling and discomfort. Patients would go through nodule rupture once the nodule contents extended into the extrathyroidal area with the discontinuity of the anterior thyroid capsule, and fistula formed unavoidably in this condition. Incision drainage was effective for rupture and early treatment of non-steroidal anti-inflammatory drug might cure the early-stage SAN. Multivariate analysis showed sex (OR = 0.13; 95% CI: 0.03, 0.61; p=.03) was the risk factor leading to SAN and males were more vulnerable to SAN.

Conclusion

SAN after MWA came earlier and initially illustrated as neck bulging, swelling and discomfort. Early detection and early treatment might prevent the rupture of nodules. Once the breakdown of thyroid capsule occurred, rupture of ablated nodules out of skin was unavoidable and invasive procedures might be the most effective treatment.

中文翻译：

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微波消融后甲状腺良性病变的症状性无菌坏死：危险因素及临床意义

摘要

背景

有症状的无菌坏死（SAN）继而结节破裂是良性甲状腺结节（BTN）热消融后的一种严重并发症。尚无研究评估其在微波消融（MWA）后的病理过程，临床表现，危险因素和治疗效果。

方法

从2012年至2019年，对398例接受BWA MWA的患者进行了回顾性检查。临床数据包括基线患者特征，影像学特征（内部血管和固体成分的比例），消融能力和时间，并发症和预后，并记录在案。

结果

十名患者（2.51％）经历了MWA后SAN，八名结节破裂患者，另两名无结节破裂。从MWA到SAN症状的平均时间为8.6天，破裂的平均时间为16.3天。SAN患者的最初症状是颈部鼓胀，肿胀和不适。一旦结节内容物延伸到甲状腺外区域，且甲状腺前囊不连续，患者将经历结节破裂，在这种情况下不可避免地形成了瘘管。切口引流术对于破裂很有效，早期治疗非甾体类抗炎药可能会治愈早期的SAN。多因素分析表明，性别（OR = 0.13； 95％CI：0.03，0.61；p = .03）是导致SAN的危险因素，而男性更容易感染SAN。

结论

MWA之后的SAN出现得较早，最初显示为颈部鼓胀，肿胀和不适。早期发现和早期治疗可能会预防结节破裂。一旦发生甲状腺囊破裂，不可避免地会出现皮肤消融结节破裂，而侵入性手术可能是最有效的治疗方法。